42820
Tonsillectomy and adenoidectomy, under age 12
Tonsillectomy and adenoidectomy, under age 12 is the #283 most-billed Medicaid procedure code, with $500.2M in payments across 495K claims from 2018–2024. The national median cost per claim is $331.68. Costs vary widely — the 90th percentile is $2,442.35 per claim, 7.4× the median.
Total Paid
$500.2M
0.05% of all spending
Total Claims
495K
Providers
1K
Avg Cost/Claim
$1K
National Cost Distribution
How much do providers bill per claim for 42820? Based on 1K providers billing this code nationally.
Median
$331.68
Average
$862.62
Std Dev
$1,042.30
Max
$7,459.15
Percentile Distribution (Cost per Claim)
50% of providers bill between $205.48 and $1,262.38 per claim for this code.
90% bill between $172.83 and $2,442.35.
Top 1% bill above $4,622.67.
About This Procedure
HCPCS code 42820 (Tonsillectomy and adenoidectomy, under age 12) was billed by 1K providers across 495K claims, totaling $500.2M in Medicaid payments from 2018–2024. This code was used for 465K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$331.68
Providers Billing
1K
National Spending
$500.2M
Avg/Median Ratio
2.60×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 42820
| # | Provider | Total Paid |
|---|---|---|
| 1 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $20.1M |
| 2 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $15.6M |
| 3 | Connecticut Children's Medical Center Hartford, CT · General Acute Care Hospital, Children | $14.5M |
| 4 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $14.2M |
| 5 | Vanderbilt University Medical Center Nashville, TN · Psychiatric Unit | $12.8M |
| 6 | Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical | $11.6M |
| 7 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $8.4M |
| 8 | Texas Children's Hospital Houston, TX · General Acute Care Hospital Children | $8.0M |
| 9 | Children's Hospital Corporation Boston, MA · Clinic/Center | $6.8M |
| 10 | Children's Hospital Washington, DC · General Acute Care Hospital Children | $6.5M |
| 11 | Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | $6.1M |
| 12 | 1932145505 | $6.0M |
| 13 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $5.8M |
| 14 | Driscoll Childrens Hospital Corpus Christi, TX · Speech-Language Pathologist, | $5.7M |
| 15 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $5.7M |
| 16 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $5.3M |
| 17 | Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children | $5.2M |
| 18 | 1306952726 | $4.9M |
| 19 | Seattle Children's Hospital Seattle, WA · Prosthetic/Orthotic Supplier | $4.9M |
| 20 | 1114958584 | $4.9M |
Showing top 20 of 1K providers billing this code